Optimal strategies for Hep B screening in younger and older patients

This month's issue of the Annals of Internal Medicine examines screening for Hepatitis B virus infection in adolescents and adults.

Dr Roger Chou and colleagues updated the 2004 USPSTF review on screening for HBV infection in adolescents and adults.

The team searched MEDLINE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and PsycINFO.

The researchers identified randomized trials of screening and treatment and observational studies of screening or the association between intermediate and clinical outcomes after antiviral therapy.

There was 1 investigator that abstracted data, and a second investigator checked them.

There were 2 investigators that independently assessed study quality.

No study directly evaluated the effects of screening for HBV infection versus no screening on clinical outcomes.

Vaccination against HBV infection was associated with decreased risk in high-risk populations.

On the basis of 11 primarily fair-quality trials, antiviral therapy may be more effective than placebo for reducing the risk for clinical outcomes associated with HBV infection.

However, differences were not statistically significant.

The research team observed that in 22 primarily fair-quality trials, antiviral therapy was more effective than placebo for various intermediate outcomes, with limited evidence that first-line antiviral agents are superior to lamivudine.

The team found that antiviral therapy was associated with a higher risk for withdrawal due to adverse events than placebo, but risk for serious adverse events did not differ.

Dr Chou's team comments, "Antiviral treatment for chronic HBV infection is associated with improved intermediate outcomes, but more research is needed to understand the effects of screening and subsequent interventions on clinical outcomes, and to identify optimal screening strategies."